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Welcome to the fourth week of the legislative session. Friday, February 5th at 5:00 p.m. marks the first cut-off. It is critical to have policy bills out of their committees of origin, or they are declared dead. As you will recall from Health Policy News last year, policy bills are exempt from this fate if they receive the coveted designation of 'necessary to implement the budget' (NTIB). It is a hectic week for all involved with trying to move their bills out of committee and along the next step in the process, which is followed by the next cut-off Tuesday, February 9th, the fiscal cut-off.

I have received many e-mails and calls this week from readers and health advocates excited about the Tobacco 21, E-cigarette, PE, and sugar-sweetened beverage bills. I love hearing from all of you and your enthusiasm, or concern about these proposals. However, I'm not the person you need to be asking to "do all you can to pass this bill or stop this bill." I'm not a legislator. You, however have two representatives and a senator who need to, and would welcome hearing from you.

In January, Whitney, Rachel, and our friend Dennis Worsham were fortunate to hear TVW Host and NPR Reporter Austin Jenkins at City Club Tacoma before the 2016 session began. In response to an audience question about impacting the legislative process, Austin replied that in his experience, constituents have about a 50/50 chance of impacting your legislator about legislation or policy you care about if you have a clear issue you can present.

My friends, if you have bills you care about, I encourage you to call 1-800-562-6000 and leave a message for your legislators. Don't worry if you don't know who your legislators are, or if you didn't vote for them. All you need to do is give your home address to the friendly operator who answers, and s/he will figure out who your legislators are and take your message down and pass it on to them.

For the latest on bills that we're tracking and what we're watching this week in Session. Click on for more Health Policy News!

Save the Date

2017 Conference - April 26 & 27, 2017 - Seattle, WA

The 2016 Science of HOPE conference delivered two full days of workshops and skill-building symposiums to encourage an asset-focused learning community around health equity. Together, we learned from the nation’s leading scientists, practitioners and policy-makers about key health equity issues. Participants left ready to engage neighbors, community and youth in hopeful, future-oriented action; acquired skills and tools to address the most complex problems of health equity in thoughtful, participatory and high-leverage ways; and were able to infuse deeper understanding of today’s leading-edge science into policy, practice and planning.

E-liquid, the nicotine-containing component, can poison children via ingestion, inhalation, ocular exposure, and skin contact. In 2015, at least 61 e-cigarette poisonings have been reported, with 59 percent involving 1 to 3 year olds. E-liquids are often sold without child resistant packaging and in alluring candy-like flavors, including caramel apple, wacky taffy and bubble gum.

In Washington, state law prohibits the sale of e-cigarettes to minors, but doesn’t do anything else to regulate e-cigarettes or the people who sell them (including online sellers). Grant, King, Pierce, Clark, and Snohomish Counties have passed ordinances regulating e-cigarettes. Other counties are considering similar ordinances.

Welcome to the third week of the legislative session! The pressure is on. If your policy bill has not been scheduled for a hearing for this week, it may not have a hearing this year. Next week most of the committee time will be spent on "executive action" or voting policy bills out of committees before the February 5th cut-off.

Last Thursday, King County Superior Court Judge William Downing ruled Initiative 1366, Tim Eyman's latest tax-limiting measure, was a thinly veiled constitutional amendment and can't be done by initiative. "It is solely the province of the legislative branch of our representative government to 'propose' an amendment to the state constitution," Downing wrote. "That process is derailed by the pressure-wielding mechanism in this initiative which exceeds the scope of initiative power."

We will be continuing to keep you updated with future status updates. If you have bill or policy questions, please feel free to direct them to Julie Peterson at juliep@healthygen.org or via twitter at healthygenjulie.

Welcome to the second week of the legislative session! Generally, our lobbyist Erin Dziedzic reports that around 450 new bills were introduced this first week of session. Things are moving fast which reflects the fact that this is a short session, which will conclude on March 10th. The first policy cut off is on February 5th! If you would like to follow the Legislative Calendar so you can monitor the next cut-off deadlines, click here.

We will be continuing to keep you updated with future status updates. If you have bill or policy questions, please feel free to direct them to Julie Peterson at juliep@healthygen.org or my Twitter handle. And for the bills that we're tracking so far this 2016 Legislative Session, click here for the full Health Policy News You Can Use!

Welcome to the inaugural issue of Health Policy News for the 2016 Session of the Washington State Legislature! We will come to you each week with updates about legislative action impacting community health.

Expectations are low for many policy bills to pass this session. It is a "short session" in an election year. Legislators will want to conclude business in their scheduled time and hit the campaign trail. As they return to Olympia, lawmakers face a budget deficit caused by increased caseloads and enrollments, and the McCleary state Supreme Court case on education. In August, the state Supreme Court delivered a unanimous order and began fining the legislature $100,000 a day for failure to develop a plan to fully fund K-12 public education as directed by its 2012 McCleary decision. The McCleary case directs legislators to boost education by billions of dollars by the 2017-18 school year. Thursday, during a briefing with reporters, legislators reviewed a plan to fund McCleary, but acknowledged finding the funding will take a year.

The Legislature will also face funding of charter schools, which were ruled unconstitutional by the state Supreme Court, the Friday before the Labor Day weekend. Initiative 1366, passed by Washington voters in November puts in the Legislature in a position where it must either send a constitutional amendment to the people requiring a two thirds vote in the legislature or a public vote for all tax increases or the state sales tax is lowered by 1% from 6.5% to 5.5% on April 15, 2016. This one percent reduction in the state sales tax would result in about a $1 billion loss in tax revenue.

Here, you can find helpful links to help you navigate during the legislative session, as well as the full text for this week's Health Policy News You Can Use!

The e-cigarette epidemic has grown exponentially over the past few years and continues to present challenges to communities and public health officials. Calls to the Washington Poison Center have nearly doubled every single year since 2010 when the first e-cigarette poisonings were reported in this state.

E-cigarettes are not subject to federal regulations, nor are the liquids used in them. The FDA is currently considering rules to regulate the fledgling industry, while the industry innovates product at an astonishing speed, while research has shown the liquids contain a wide variance in nicotine content. Consumers who wish to use the devices for cessation may actually be using higher levels of nicotine then if they were smoking combustible cigarettes.

In the last 2 years, the Washington State Legislature has considered various policy options to deal with e-cigarettes without the passage of final legislation. The policy options on the table have included: taxation, retailer licensing, child-safe packaging, restricting the age of sale to those age 18+, requiring disclosure of nicotine content and toxic or carcinogenic chemicals in the liquids, prohibiting internet sales, etc. Meanwhile, local health departments are considering policy regulations through board of health ordinances, or are leading community conversations about the devices. However, the infancy of the health impact research complicates policy discussions.

Background

E-cigarettes, or vape pens, are increasingly popular products that deliver nicotine and other harmful ingredients to users and bystanders, yet no federal regulation of these products currently exist. The American Public Health Association has recommended that states and municipalities enact laws prohibiting the use of e-cigarettes in enclosed public areas and places of employment due to their potential as a source of pollutants. Recentresearchhas suggested that contrary to some opinions, e-cigarettes may not be effective tobacco cessation aids and may even inhibit the ability to quit. In 2014 and 2015, 33 Attorneys General submitted letters urging the FDA to require warning labels and childproof packaging, as well as restricting advertising, prohibiting flavoring, and other restrictions. Although the FDA is considering warning label and childproof packaging regulations, there is still no way to verify ingredients or safety claims made by manufacturers.

Impacts on Children & Youth

The 2014 Healthy Youth Survey found that one in five high school seniors in Washington reported e-cigarette use, almost triple the amount reported in 2012. This dramatic increase indicates the growing social acceptance of e-cigarettes among teens, which threatens to undermine decades of anti-tobacco education and advocacy. This is worrisome for many reasons, including because nicotine is particularly harmful to brain development in children and adolescent smokers are more likely to continue into adulthood. There is also early evidence that teens who vape are more likely to take up traditional combustible cigarettes. Manufacturers of e-cigarettes are not subject to the same advertising rules as the tobacco industry and therefore can market their products using celebrity endorsements or cartoon characters that appeal to children. Vaping products are also available in candy-like flavors that are attractive to younger users.

E-liquid, the nicotine-containing component, presents a poisoning threat to children via ingestion, inhalation, and skin contact. Exposure to even tiny amounts of e-liquid can cause vomiting, seizures, and death. A CDC study found that the number of calls to poison centers related to e-cigarettes had increased from one per month in September 2010 to 215 per month in February 2014. More than half of these calls concerned children under the age of 5. In 2015, the Washington Poison Center has reported 58 e-cigarette poisoning exposures, including 40 pediatric cases. Eighty-five percent of these exposures concerned children between the ages of 1 and 3.

The use of e-cigarettes to consume marijuana and synthetic drugs is also a growing public health concern. A recent study of high school students in Connecticut found high rates of vaporizing marijuana. Because vaping can be almost completely odorless, users are able to smoke marijuana in public places without detection. Marijuana use on school property is of particular concern for this reason. E-cigarettes can also be used to vaporize highly dangerous drugs such as synthetic marijuana.

Regulation

E-cigarettes pose unique regulatory challenges to state and local authorities. In Washington, it is illegalto sell e-cigarettes or other vaping products to minors under the age of 18. However, because vaping products can be purchased online sales are difficult to monitor. Grant County, King County,Pierce County, Clark County, and the city of Pascocurrently have ordinances in effect prohibiting the use of e-cigarettes in all areas where smoking is prohibited. Clark, King, and Pierce Counties also prohibit free sampling of vaping products. Grant County prohibits possession of any vaping product or device by anyone under the age of 18. King, Pierce, and Snohomish counties are currently considering new or revised e-cigarette ordinances.

The American Academy of Pediatrics just yesterday issued this statement: "The AAP now strongly recommends the minimum age to purchase tobacco products, including e-cigarettes, should be increased to age 21 nationwide."

"Tobacco use continues to be a major health threat to children, adolescents and adults," said Karen M. Wilson, MD, MPH, FAAP, chair of the AAP Section on Tobacco Control and section head of Pediatric Hospital Medicine at Children's Hospital Colorado. "The developing brains of children and teens are particularly vulnerable to nicotine, which is why the growing popularity of e-cigarettes among adolescents is so alarming and dangerous to their long-term health."

It seems to me, we may not know everything there is to know about e-cigarettes, but we know enough to adopt policies to protect children and adolescents.

How are social services professionals using NEAR (Neuroscience, Epigenetics, Adverse Childhood Experiences, and Resilience) science and knowledge? Home visiting and mental health professionals, along with other experts have come together to create, review and test a new toolkit designed as a training manual with guided processes to safely and effectively talk about the trauma of Adverse Childhood Experiences.

The NEAR@Home toolkit, designed over a three plus year period by federal Health Resources and Services Administration Region X (Alaska, Idaho, Oregon and Washington), Quen Zorrah (Thrive WA), Laura Porter, and others, is a "guided process to talk about trauma and resilience in Home Visiting".

The 2015 Washington State Legislature adjourned on Friday, July 10th. This was officially the longest legislative session in history at a record 176 days and three special sessions to reach agreement on a two-year $38.2 billion operating budget. The 2015-2017 operating budget includes $180 million in new revenue after closing and extending some tax preferences and increases spending by $4.4 billion from the current 2013-2015 biennium operating budget. Details are shared here in this article from Crosscut.

A $3.925 billion Capital budget and a $16.08 billion transportation package was passed before the legislature adjourned Sine Die. For details about all three budgets, including links to bills and project maps, click here.

And for more Health Policy News You Can Use, and what we were tracking this legislative session, read on here.

The Healthy Living Collaborative (HLC) is constantly focusing on upstream solutions that support community-based initiatives to improve health and wellness. The HLC is committed to strengthening families, neighborhoods, and systems in order to ensure health equity. HLC brings together partners from all sectors, combining resources and ideas, to improve the lives of everyone.

Click on the link to the Healthy Living Collaborative's 2015 Strategy document to see what the policy priorities are for this year.

The Learning Institute's Laura Porter participated in a recent webinar for the National Association of State Mental Health Program Directors (NASMHPD) on Adverse Childhood Experiences (ACEs) and the role of health systems in building resilience:

Adversity, Resilience and the Role of Health Systems in Prevention

Adversity in childhood, particularly in the absence of protective factors, can have profound developmental consequences. If not addressed, childhood adversity can initiate a “cascade” of risk factors, often leading to behavior problems, school failure, substance abuse and other negative outcomes. Health care personnel are in a unique position to identify and intervene early in this process. By educating families, strengthening protective factors, and working with children to build resilience, health care workers can help to prevent the onset of problems later in childhood or adolescence.

This webinar provides a brief overview of adversity, resilience, and implications for prevention of substance abuse and other negative outcomes. It also describes effective prevention approaches in a variety of healthcare settings, including pediatric hospitals, emergency departments, school health clinics, and home visiting programs. Particular attention is paid to a dual-generation approach and to building partnerships for prevention.